Aphasia Flashcards
Define communication
- active process of exchanging information and ideas
- includes: gestures, vocalizations, verbalizing, signs, pictures, symbols, printed word, and output from augmentative and alternative (AAC) devices
what is the difference between receptive and expressive language?
- Expressive → ability to communicate one’s thoughts, ideas and feelins
- Receptive → ability to understand what another person is communicating
Which cranial nerves are involved with speech?
CN V, VII, IX, X and XII
what is the general function of CN IX?
- Taste
- Swallowing
- Elevation of pharynx and larynx
- Parotid salivary gland
- Sensation to posterior tongue and upper pharynx
What is the general function of CN X?
- Taste
- Swallowing
- Elevation of palate
- Phonation
- PNS outflow to visceral organs
What is the Central Language Mechanism?
essentially how the brain functions when we’re talking and comprehending speech
What are the brain regions and major components of the Central Language Mechanism?
- Broca’s Area
- Primary motor cortex
- Arcuate fasciculus
- Angular gyrus
- Wernicke’s area
- Supramarginal gyrus
- Corpus callosm
- Subcortical regions:
- Thalamus
- Internal capsule
- Striatum
- Globus pallidus
- White matter tracts
what is Broca’s area responsible for?
Motor programming for articulation
(expression of language)
what is the role of the primary motor cortex regarding speech?
activation of muscles for articulation
(dorsal frontal lobe)
what is the role of the Arcuate fasciculus?
transmission of linguistic info to anterior areas from posterior areas
(bundle of axons that generally connects the Broca’s area to Wernicke’s)
What is the role of the Angular gyrus?
integrates visual, auditory, and tactile info and carries out symbolic integration for reading
(parietal lobe)
what is the role of Wernicke’s area?
comprehension of oral language
(temporal lobe)
what is the role of the supramarginal gyrus?
symbolic integration for writing
what is the role of the corpus callosum regarding speech?
transmission of info between hemispheres
- C-shaped nerve fiber bundle found above the thalamus, under the cortex
what is the role of the thalamus regarding speech?
naming and memory mechanisms
What is the role of internal capsule, striatum, and globus pallidus regarding speech?
play a general role in speech and language
part of the basal ganglia
What is aphasia?
Neurogenic language disorder resulting from an injury to the brain
(typically the L hemisphere)
Aphasia can happen in all 4 language modalities: ___________________
- expressive language
- receptive language
- reading
- writing
List the 8 dimensions of Aphasia
- Fluent versus nonfluent
- Grammatical integrity
- Volitional reception
- Auditory comprehension
- Writing disorder
- Reading disorder
- Expression of names
- Response dynamism
what is generally included in testing for aphasia?
- Naming task → visual confrontation
- Speech sample → spontaneous conversation
- Repetition
- Comprehension of spoken language
- Reading
- Writing
Fluent speech aphasia goes with ______
Wernicke’s aphasia
Nonfluent speech aphasia goes with _______
Broca’s Aphasia
how is fluent speech defined?
rate of speech, length of utterance, ease of production, prosody
Describe a fluent speech pattern
- Long utterance → 9 or more word per utterance
- Utterances are easily produced
- Prosody is normal
- Logorrhea → produces lots and lots of speech
- Pressed for speech → the person seems compelled to keep going, getting out lots of ideas through fast and continuing ideas
Describe a nonfluent speech pattern
- rate is slow (10-50 wpm) with lots of pauses
- utterances are short 1-3 words
- speaking seems effortful
- Prosody is often lost
What is pure word deafness?
auditory verbal agnosia
person hears the word but cannot tell you the meaning of the word; inability to comprehend speech
What is agraphia?
loss the ability to write
- Pure agraphia → agraphia is the only communication deficit resulting from focal lesion (very rare)
- Paragraphias → incorrect spelling errors caused by brain damage
What is response dynamism? list the various types
utternaces that are uncontrolled; spontaneous conversation
- Stereotypy
- Verbal perseveration
- Pallilalia
- Echolalia
define stereotypy
a short utterance used exclusively in all speaking attempts it can be a word of a phrase
monophasia → when a pt only has one word available (usually a swear word)
what is verbal perseveration?
a word or phrase temporarily becomes the response to all stimuli
at the outset of this period, the response was appropriate to a particular stimulus
what is pallilalia?
uninhibited repetition of one’s own utterances
“John Smith, John Smith”
What is echolalia?
uninhibited repetition of another’s utterances
“where do you live? Where do you live?”
List the various distinct aphasia syndromes
- Broca’s aphasia
- Transcortical Motor aphasia
- Global aphasia
- Anomic aphasia
- Conduction aphasia
- Wernicke’s aphasia
- Jargon aphasia
- Thalamic aphasia
- Subcortical aphasia
Describe Broca’s Aphasia
- Nonfluent aphasia
- usually an occlusion of L MCA (superior division)
- characterized with:
- awkward articulation
- restricted vocab
- restriction to simple grammatical forms in the presence of a relative preservation of auditory comprehension
- Writing typically mirrors speech
- reading may be less impaired
Describe Wernicke’s Aphasia
- Fluent Aphasia
- usually an occlusion to L MCA (inferior division)
- lesion to posterior superior temporal gyrus
- Impaired auditory comprehesion and fluently articulated speech marked by word susbstitution
- Reading and writing usually severely impaired
- Speech often produced at greater rate than normal
- Production of speech is often precise - but pts my reverse phonemes and or syllables
Describe Jargon Aphasia
- Fluent aphasia in which speech is incomprehensible but makes sense to the pt
- they either replace the word with a similar sounding one or its random
- associated w/Wernicke’s aphasia
Describe Anomic Aphasia
- Word finding difficulty within fluent, grammatically well-formed speech
- lesion is variable but commonly in left angular gyrus
- Speech output is vague, pt may use circumlocution as a comp strategy
- using wordy and indirect language to express ideas when unable to retrieve the desired word(s)
- these disturbances predominate aphasia secondary to TBI
- Anomia is the most prominent symptom w/only limited receptive/expressive deficits
- may appear as the isolated syndrome or be the final stage of recovery from others
Describe Conduction Aphasia
- main impairment is inability to repeat words/phrases
- AKA associative aphasia
- mild form of aphasia and relatively rare
- Caused by lesion in arcuate fasciculus
Describe Global Aphasia
- Severe aphasia w/complete dysfunction across ALL language modalities
- extensive damage, anywhere left hemisphere and sometimes bilateral
Describe Transcortical Aphasia
- Wernicke’s term for any aphasic syndrome whose lesion falls outside of the Perisylvian area
- Ability to repeat w/good accuracy is retained
- 3 general types recognized
- transcortical motor aphasia
- transcortical sensory aphasia
- mixed transcortical aphasia
what is transcortical motor aphasia?
- nonfluent speech w/greater effort required than Broca’s
- repetition and comprehension intact
what is transcortical sensory aphasia?
fluent speech marked with paraphasias w/semantic and neologistic substitutions, poor comprehension, good repetition
What is mixed transcortical aphasia?
severely disordered language except in repetition.
Echolilias is common
Describe subcortical aphasia
- generally characterized w/preserved repetition
- broken down into:
- striato-capsular and white matter → lack of speech fluency, occurence of literary paraphasias, mainly preserved comprehension and naming
- thalamic aphasia → relatively consistent fluent expressive speech and impaired comprehension marked by verbal paraphasia and neologisms. Auditory and reading comprehension usually remain intact
Describe Progressive Aphasia
- this is a type of dementia
- characterized by:
- gradual loss of language function in the context of relatively well-preserved memory, visual processing, personality until the advanced stages
- Anomia is often an early sign
- not due to stroke, trauma, tumor, or infection
- spontaneous recovery does not occur
What is dysarthria?
impairment of speech production resulting from damage to the central or peripheral nervous system, causing weakness, paralysis or incoordination of motor speech
list treatment options for dysarthria in acute care
- slow rate of speech
- over-articulate
- speak louder
What is apraxia of speech?
reflects an impaired capacity to plan or program sensiromotor commands necessary for directing movements that result in normal speech
T/F: apraxia of speech involves muscle weakness
FALSE
also doesn’t involve: paralysis, spasticity, or involuntary movements typically associated w/dysarthria
or language comprehension/production deficits common with aphasia
how would you describe apraxic speech?
labored speech
difficult to initiate speech
periods of error free speech followed by errors as speech progresses
T/F: individuals with aphasia sound normal when singing
FALSE
normal sounding w/singing = apraxia
What is dysphagia?
swallowing disorder
common in stroke, brain injury, spinal cord injury, PD, MS and many other neurologic disorders
